Therapeutic Advances in Gastroenterology (Oct 2017)

The prognostic value of histology in ulcerative colitis in clinical remission with mesalazine

  • Giuseppe Frieri,
  • Brigida Galletti,
  • Mirko Di Ruscio,
  • Rachele Tittoni,
  • Annalisa Capannolo,
  • Donatella Serva,
  • Giovanni Latella,
  • Laura Sollima,
  • Pietro Leocata,
  • Stefano Necozione,
  • Rosamarie Frieri,
  • Angelo Viscido

DOI
https://doi.org/10.1177/1756283X17722926
Journal volume & issue
Vol. 10

Abstract

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Background: The aim of the study was to compare the prognostic value of histological and endoscopic activity in patients with ulcerative colitis (UC). Methods: Patients in clinical remission for 1 year under treatment with mesalazine underwent a planned colonoscopy with biopsies. Histological activity was scored using the histological activity index (HAI). Endoscopic activity was scored using the Mayo endoscopic subscore (MES). The clinical course was evaluated measuring relapses needing steroids during a follow up of 3 years. Results: A total of 52 patients were enrolled into the study and followed up for 3 years. At baseline 29 patients (55.77%) had no endoscopic lesions, and 17 patients (32.69%) showed no histological alteration. At 3 years of follow up, overall, 26 patients (50%) were still in steroid-free remission. Using univariate logistic regression analysis, both histological (HAI ⩾ 1) and endoscopic activity (MES ⩾ 1) were significantly associated with outcome, showing, respectively, a relapse risk (odds ratio [OR]) 16.4 times higher than histological remission (HAI 0) (96% confidence interval [CI]: 3.2–84.3) and 6.3 times higher with respect to endoscopic remission (MES 0) (96% CI: 1.9–21.3). After multivariate logistic regression analysis, histological activity was the only factor significantly associated with outcome (OR 10.2; 95% CI: 1.7–59.4). Conclusions: Histological activity has the most powerful prognostic value in predicting the need for steroids in patients with UC in stable clinical remission on mesalazine. It could be considered as a target of therapy in UC.